Provider Demographics
NPI:1467099770
Name:LEAPLEY, KYLE ANDREW (ATC)
Entity Type:Individual
Prefix:
First Name:KYLE
Middle Name:ANDREW
Last Name:LEAPLEY
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:994 E 2000TH ST
Mailing Address - Street 2:
Mailing Address - City:LIBERTY
Mailing Address - State:IL
Mailing Address - Zip Code:62347-3405
Mailing Address - Country:US
Mailing Address - Phone:217-617-3412
Mailing Address - Fax:
Practice Address - Street 1:3032 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:IL
Practice Address - Zip Code:62301-3708
Practice Address - Country:US
Practice Address - Phone:217-617-3412
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-05
Last Update Date:2019-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20160268512255A2300X
IL0960041232255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer